Provider Demographics
NPI:1699746552
Name:WILLIAMS, JERRY BRENT (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:BRENT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-539-4080
Mailing Address - Fax:256-539-4099
Practice Address - Street 1:1120 S JACKSON HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5777
Practice Address - Country:US
Practice Address - Phone:256-381-8811
Practice Address - Fax:256-381-5151
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11854207RC0000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
25-10012OtherUNITED HEALTHCARE
MS07887859Medicaid
AL112590Medicaid
AL112603Medicaid
4198103OtherAETNA
AL510-49320OtherBCBS
AL510-49461OtherBCBS
AL51049461OtherBCBS
AL51521840OtherBCBS
P00138871OtherRAILROAD MEDICARE
ALP00742166OtherRAILROAD MEDICARE
AL009954995Medicaid
AL112594Medicaid
AL510-49319OtherBCBS
AL112590Medicaid
ALP00742166OtherRAILROAD MEDICARE
AL051521840Medicare PIN